Join me as I half-ass my way through medical school, encountering all sorts of freaks (patients, classmates, myself, etc.) along the way

Sunday, September 18, 2005

Where's The Love?

During the process of pre-rounding and recording vitals for sixteen (yes, sixteen) of our team's patients yesterday morning (what, you have something better to do between 5 AM and 6:30 AM on a Saturday after having been up the whole night?), I found myself incredibly frustrated trying to decipher what the nurses had written in the chart over the course of the last 24 hours. 300 cc urine at 4AM, with the 3 crossed out, a 0 added in front, a 2.7 thrown in the middle, and a drop of espresso covering the remainder of the corrections. Unreadable abbreviations for things that make no sense, like BRP X F (I know the BRP is for "bathroom privileges", but that's about it) and JPDNC (not even going to try with that one). Of course, this is ignoring all of the times where there is absolutely nothing recorded for an entire shift (no BP, no pulse, no ins/outs...nada), leaving me with nothing to report when we round. This then leads to the chief checking the chart during rounds and often finding vitals recorded at "5:30AM", with a full set of vitals that has miraculously appeared during a time vortex somewhere between 5:30 and 7:00 AM that allowed the nurse to travel back through time, take the vitals, record them, and return just in time to watch me look like a total idiot in front of everyone.

Add to this the frustration of being screamed at by scrub nurses for the cursed sin of taking up space, being given attitude for going so far as to ask a nurse how a patient was doing, and being accused by one nurse of being a prank caller when I asked about one patient's antibiotics over the local phone system from a floor below ("How do I really know you are a medical student and not some prank caller?" I mean, c'mon now, if that's what prank calling has actually come to these days, Haywood Jablomie and Mike Rotch must be rolling in their graves), and it's pretty clear that my introduction to the doctor-nurse divide has not been that smooth.

Of course, if this was just a one-sided battle, I would be ignoring half of the truth. Let's put aside for a moment the fact that the previous sentence, if you really starting thinking about it, makes no sense at all. From what I have observed regarding the nursing perspective (and to any nurses out there, please feel free to chime in with stories of your own), it goes without saying that they put up with a serious wad of shit on a daily basis, and not just from patients code brown-ing* all over the place. They have to deal with doctors barking orders at them all the time, demanding instant gratification of said orders, and then getting upset half the time if the nurses do the orders written down because the doctor had since changed his or her mind and was expecting the nurse to read minds and change the plan accordingly. There's surgeons who tell the scrub nurse to do five different things at the same time, and then ask why nothing is ready to go that second. Between ward time and OR time, I've seen plenty of doctors scream at nurses on a daily basis in a horrific condescending tone, with one doctor getting so infuriated with a nurse over something that was not even her fault he called up the administration people and demanded that she be fired on the spot. Ouch.

A downward spiral has been created, with doctors hating nurses and nurses hating doctors. Doctors start screaming at nurses automatically, and nurses respond by not even doing what the doctors order until the last possible second for no reason other than pure, unadulterated spite. Doctors telling me about how nurses are "all a bunch of lazy fat cows, those damn cows." (Yes, that exact analogy has been used on multiple occasions). Nurses confiding in me that "the chief resident is the most awful human being I have ever met." And so on, and so forth. It has become evident to me over the past few months that, going against all those classic porn movies I was brought up on that invoked the sacred and genuine love between doctors and nurses, there is actually a lot of animosity between these two parts of the medical establishment.

So the question remains, how to remedy this situation, this tussle, this eternal struggle between two war-torn factions eager to tear each other apart limb from limb? This is a tough question, because it seems as if a distance has developed between these two groups, and there is simply not enough communication going on. This is compounded by a lack of continuinty, as doctors and nurses do not even know each other most of the time because the teams and shifts change so often.

Given the demands of modern health care delivery and this need to constantly change things up, how can we as professionals tear down this metaphorical wall of hatred as efficiently as possible? The answer, my friends, is quite simple. What we need to do is just collectively get over ourselves, get over our positions, our responsibilities, and our backgrounds...and have one big, massive, sweaty orgy. Right at the nurses station. In front of all the patients. Lasting as long as possible (which means until one of the many junkie patients calls the nurses desk with a request like "I'm in so much pain, can you please just give me another ten vicodin?"). Look, I'll be willing to overlook the fact that you're very likely to be a morbidly obese Philipino woman in her 50's with more facial hair above your lip than I have on my entire body, if you can ignore the fact that I am probably going to be about as good at pleasing you in bed as I am at collecting the aforementioned patient vitals (i.e. not that good). I think this will go a long way towards helping everyone just relax, do their jobs, and work harmoniously together.

Barring this development, the least we could do is stop pretending like we are fighting each other over all of these rather petty details and territorial concerns, but instead become united around the fact that we share a common enemy, one so vile, so terrible, so fearful, that we must do all we can to protect each other from this creature. Who am I referring to? The patients, of course.

*Much like Code Blue (patient dying) and Code Red (fire in hospital), Code Brown has earned its way into hospital lore by signifying when a patient has managed to crap his or her pants, except since they aren't wearing any pants and are instead wearing a hospital gown with an exposed back, all of the poo gets on the sheets, bed, floor, hallway, and, sometimes, if you're really lucky, your white coat.

this post really described the tensions btwn doctors and nurses well. As a working nurse, I can relate to it well. The lack of respect at work infuriates me. And no, It's NOT sexual tension! It is pure dislike, repulsion, disrespect,mixed with many big egos. I don't know if it will ever change...and it's tragic for everyone esp. patients.

Yeah, that was pretty funny....but no, not sexual tension. How about...more to do than one human being can possibly do in a 12 hr shift, over work, mandatory overtime, no lunch/dinner, hardly get to the bathroom(I need a foley and IV coffee to keep going), too much coffee, patients screaming, families screaming, bosses demanding, doctors....well, you said it, patient is going bad, supervising LPN with 12 of her own patients, sacrificing important times with our families (this is no mon-fri 9-5 job), the possibility of a lawsuit hanging over our heads, have to get the charting done!!, ethical dilemmas, CYA, family situations, gotta get the dog to the vet when I have a day off...yeah, next month, and heaven forbid I call in...., and finally, our own drive to be perfect, beacuse if I'm not perfect, I could end up killing someone.....This is some of what nurses deal with on a daily basis.

I don't mind the docs were I work. Then again, I don't work on a surgical floor.

Docs have more patients than nurses. It leaves little time for courtesy.

Some doctors do stupid things, like push versed and ativan on confusion patients with intracranial bleeds, then the patient becomes a 1:1 and royally fuck up the nursing workload on the floor. Or when doctors start fighting over who's running the code....

I agree though, it's silly. The best thing docs can do is to seek input from the nurses. The best thing nurses can do is speak up, and realize that doctor's orders are for patients and not for the nurses.

I am a nurse who has worked on several different floors in several hospitals, and I think are the worst. I once had a surgeon yelling at me because he said that a 3 liter blood loss post knee replacement was normal and how dare he be called about the situation. Most of the non-surgical docotrs are much more plesant to work with.

I think the biggest problem is that doctors have no idea what nurses do, and nurses don't understand the full spectrum of what the doctor is doing. (Although if I could read the handwriting on the progress notes, it would help).

I'm an RN student in Regina, Sk. and i feel your pain. Everybody hates everybody else, I mean maybe I'm just naive, maybe I'm a dreamer, but if everybody shut the hell up and was respectful of all the other professionals it would be a lot easier to get quality patient care done. It's natural for people in the crappy state of our overloaded, understaffed health care system to get jaded/burnt out/generally angry at the world, (I can't comment on the U.S. system, but I hear it's no hell either) but then patient care is compromised. As an almost nurse, I could be crusified if anyone found out that I said what I'm about to say, but here goes.... I blame the nurses. It's a fact that the majority of the nursing body (and that is the largest collective of health care providers in the continent) doesn't get any respect because we don't demand respect, and don't reflect respect on others, thus leading to rediculous tensions that turn into petty sniping. Besides who wants an orgy with a 8 peri-menopausal grandmothers with bad backs and varicose veins where god never meant for varicose veins! Anyway, I love your blog, keep it up (hopefully without need for Cialis!)http://boneybuckethead.blogspot.com

i think that orgy would be a satisfying solution for many a workplace. remember it isn't just doctors and nurses who share animosity... an orgy at my work would realy spread the love (unfortunately, even though you could manage to overlook the 50 year old philipino woman, i could not bring myself to engage in any sort of anything with my boss!)

Hey--Your Blog is a great diary of your learning experiences. Humor gets us all through most things. It should be no surprise that there are things that they don't teach you in medical school, and most docs find it out too late and leave (too bad for us all). I am just getting started so check in once-in-a-while. Forewarned is Forearmed!!

I, being the naive little girl that I am, did not know that such animosity existed between doctors and nurses . . . and seeing as I'm a first year student nurse, I'm now relatively apprehensive. I hope that my relationships with the doctors I will encounter on duty will be pleasant enough . . .

I wouldn't mind that orgy to make things better, though. :D And while I am a Filipina girl, I can assure you that I am not 50, obese, nor particularly hairy. XD

I can identify with your statement: "I've seen plenty of doctors scream at nurses on a daily basis in a horrific condescending tone, with one doctor getting so infuriated with a nurse over something that was not even her fault he called up the administration people and demanded that she be fired on the spot. Ouch." This has happened to me as well,exactly as you stated, I am an OR nurse in Philadelphia...I thought they taught that kind of behavior in Medical School...seems so universal...anyway, I always try to get along with my docs, in my experience, I always thought, if I am focused on getting the case done, being 5 steps ahead of the surgeon, foreseeing any problems and nipping them in the bud before the "good doctor" recognizes them then I would at least be spared the condescending attitudes...and I do not mind yelling, bitching, ranting or raving as long as it is not directed at me personally, everyone needs to vent, but attacks on other people should not be acceptable...most of the time when I have been involved in these indidents in the OR, it has been because the doctor has done something, like detach the retina with the 25 gauage needle I just gave him...and he is shitting his pants. Anyway funny how when a doctor complains to administration, a huge investigation ensues but my written documentation has been ignored for months...and then they say, "after we have spoken with everyone in the roon that day, we will get back to you...." They haven't yet, maybe because everyone in the room said the same as me and they realized said doc was trying to have his own power play...(he threatened to get me fired in the middle of pre-op full of patients awaiting surgery and then proceeded to call administration)... at least this holds true for Ophthalmology (the epitome of pompous) and I have found Neurosurgeons to be especially appreciative, at least the ones I work with (we all go out drinking together). As for my views in a nutshell, we are all a team and we should act like it, get rid of the egos...come to think of it...here's 2 stories I will share...1- doc grabs a drape with an attached bag used to catch draining fluid, applies it to the patients head UpSide Down, endures irrigation soaking his scrub pants the whole case and then at the end stands up and reprimands the scrub for putting the drape on backwards...go figure that one out...2-doc asked me to get 5 things rapid fire (case was scheduled by his office incorrectly) so I start aquiring said items and start opening them on the field, he then yells,"Stop paying attention to the things you are paying attention to and pay attention to this case!!!!!!" ...???...

hey there! I wasn't really searching for blogs and I happen to saw yours.. Are you a medical student? Or a doctor already? I'm a college frosh and has plans of entering a med school but the problem is medicine just takes too long to pursue.. Is medicine hard? What country are you from? I hope to hear from you soon..

hey there! I wasn't really searching for blogs and I happen to saw yours.. Are you a medical student? Or a doctor already? I'm a college frosh and has plans of entering a med school but the problem is medicine just takes too long to pursue.. Is medicine hard? What country are you from? I hope to hear from you soon..

(4th year med student)Yeah, man.I put the blame for this squarely at the feet of the doctors. Doctors are the leaders of the treatment team, and nurses are like the seargents--to carry out orders. A good nurse is worth his/her weight in gold--just in case, treat all nurses well. Know their names, ask how they are doing--they will be eating out of your hand before long. If I ever found myself yelling at a nurse, I would immediately hide my head in shame, for either failing to set a good example, earning respect by giving it and doing excellent work, or for giving a task that was too difficult for that person (not all nurses are created equal). The doctor, and ultimately the patient, always lose whenever there's an argument. That's what nurse managers are for--they are earning 100K+, make them earn it.

And remember, when the nurse pages you, the intern, at 4:00 in the morning to ask if tylenol is okay for that patient, remember that they are testing you--

This is a vein and vascular center that has multiple locations. They are located in near PHOENIX, ARIZONA, USA. Office locations are, Surprise, Arizona, USA, - Goodyear, Arizona USA, Chandler, Arizona USA and Gilbert , Arizona USA. These cities surround Phoenix, so we want to focus on each city and about a 20 mile radius around each one as well as Phoenix itself since it is in the center of all these cities.